Thrombectomy and thrombolysis are often advocated in the treatment of phlegmasia cerulea dolens, but frequently result in incomplete clot removal, recurrence of
thrombosis, local and systemic hemorrhagic complications and chronic venous stasis; this state is associated with a rate of major
amputation and death of up to 50%. Non-operative
therapy includes elevation, hydration and heparinization and excludes all methods aimed at surgical removal or chemical lysis of the
thrombus. In 1982 it was decided to use non-operative
therapy as the first line of treatment for phlegmasia cerulea dolens. In the last 9 years seven extremities in six patients with this condition have been treated. One patient had advanced
gangrene on presentation and one underwent emergency
thrombectomy. Five extremities (in five patients) were treated with non-operative
therapy.
Ischemia was rapidly corrected in all five patients.
Edema resolved completely after 3-4 days in four patients. There were no complications attributable to the
therapy. Two of six (33%) patients died from terminal disease. Non-operative
therapy appears to be effective in preventing limb loss and avoiding the risks of
thrombectomy and thrombolysis in
critically ill patients.